Are You Your Mother’s Keeper?

By Heidi Rai Stewart and Matthew J. Lautman

Pennsylvania's Filial Support Law Can Hold Children Responsible for Their Parents' Medical Expenses

Most parents prefer not to become a financial burden on their children as they age or lose their independence. This desire, however, may be thwarted by a decision of the Pennsylvania Superior Court which spotlights a relatively obscure law requiring children to be responsible for the financial liabilities of their parents. Under that law, children in Pennsylvania can be directly liable for their parents' medical expenses, including the costs of nursing-home care.

Parental-support laws, also known as filial-support laws, have a long history in the United States. These laws place a personal legal obligation on adult children or certain other relatives to protect, care for, and support their impoverished family members. Many of these laws trace their origins back centuries to "poor laws" that required people to care for their destitute relatives. Twenty-nine states and Puerto Rico have some version of a filial-support law.

Pennsylvania's filial-support law has been on the books since 1771 and is one of the broadest in the nation. The current law provides that individuals "have the responsibility to care for and maintain or financially assist" their "indigent" spouses, parents, and children. The amount of financial support that must be paid by the responsible person is generally determined by a court. The law is only specific as to the payment of medical bills (but not nursing-home bills) for the aged. Specifically, the maximum annual financial liability for a responsible family member is the lesser of: (1) six times the excess of the responsible family member's average monthly income over the amount required for the reasonable support of the responsible person and other persons dependent upon the responsible person; or (2) the actual cost of the medical assistance for the aged relative.

There are certain exceptions to the law. A family member does not have to financially assist a relative if the family member "[does] not have sufficient financial ability to support the indigent person." In addition, a child is not required to pay for the upkeep of an indigent parent if the parent in question abandoned the child and "persisted in the abandonment for a period of ten years during the child's minority." Terms like "indigent" and "sufficient financial ability" are not clearly defined in the law leaving them up to interpretation by the courts.

The Pennsylvania Superior Court ruled in a 2012 case that a son was liable under the filial-support law for nearly $93,000 in nursing-home costs incurred by his mother. John Pittas was a small-business-owner when his mother was injured in an auto accident and entered a nursing home for rehabilitation. Mrs. Pittas applied for Medicaid, but while her application was pending, she left the nursing home and moved to Greece to live with her husband and adult daughters. Mrs. Pittas left behind a large unpaid balance owed to the nursing home. John was the only child still living in the United States, so the nursing home sued him for the unpaid bills under Pennsylvania's filial-support law.

While John initially prevailed before a panel of arbitrators, the trial court eventually ruled in favor of the nursing home. John appealed the decision to the Superior Court arguing the trial court improperly placed the burden upon him to prove his inability to financially support his mother, and that the trial court should have considered other possible income sources such as his mother's husband, her other grown children, and her pending application for Medicaid. The appeals court rejected his arguments and affirmed the trial court's decision. A three-judge panel of the Superior Court held that the filial-support law does not require a trial court to consider other sources of income or to stay its determination pending the resolution of a claim for Medicaid. The panel also held that the nursing home had the ability to choose which family members to pursue for the outstanding debt, and if John wanted other family members to share in the burden he should have brought them into the case as third-party defendants. The Superior Court concluded that John was personally liable for the entire lump sum of $92,943.41, and that amount would also be subject to Pennsylvania's statutory interest rate of six percent.

It remains to be seen what impact this case will have and whether health-care facilities and other creditors will look to this law to file more support actions against the spouses, children, and parents of individuals with outstanding bills. It is important to note that while the Pittas case dealt with a mother-son relationship, Pennsylvania's law applies not only to children but also to spouses and parents. Family members need to be aware that they can be held liable for the unpaid medical bills of their spouses, parents, and adult children. For example, John's mother did not need skilled nursing care due to old age-but rather as a result of being injured in an accident. A parent can similarly be liable for the long-term-care expenses of an adult child who has been disabled by injury.